Exploring the effects of the past civil war in terms of the prevalence and associating factors of PTSD

Abstract

The Sri Lanka Army experienced a civil war, which ended in 2009. PTSD is a chronic psychological complication following trauma associated with war, and this study intends to explore the extent of PTSD ten years after the civil war in the Army.Aims:This study aimed at describing the prevalence of PTSD and its associated factors among armed personnel with combat experience.Methods: This was a cross-sectional study, conducted in 2019, in the East of Sri Lanka with a total sample of 3365. The other ranks were selected from 71 clusters by multi-stage cluster sampling method whilst the officers were selected by systematic random sampling method from the Officers’ Seniority List. The locally validated PTSD checklist military version (PCL-M) questionnaire was used to screen PTSD. A standard questionnaire was used to obtain data on sociodemographics, aggression, smoking, and cannabis usage, whereas locally validated tools (PHQ-9, Chalder fatigue scale, and AUDIT) were used to gather information on psycho-logical and behavioral factors. Data were analyzed with SPSS-20, and the significance of factors associated with PTSD (p≤0.05) was determined by the Chi-Square test. Multiple logistic regression was used to exclude confounders. The study was conducted after the ethical clearance from the Ethical Review Committee of the Faculty of Medicine, KDU.Results: Of the sample, 1845 (75 officers and 1772 other ranks) had combat exposure and were chosen for this study. The prevalence of PTSD was 3.9%. Battle events and consequences, probable depression, fatigue, high-risk drinking (HRD), childhood abuse, expression of aggression, psychiatric family history, inward admission, absenteeism, and psychosocial dysfunction were significantly associated with PTSD. After adjusting the odds ratios, probable depression, fatigue, aggression, and family history of mental disorder, were predictive of PTSD.Conclusions: Even after ten years, the psychological effect of the civil war persists. Early exposure to childhood abuse, psychiatric family history, and younger age at combat exposure could be risk factors for PTSD, and HRD, depression, fatigue, psychosocial dys-function, absenteeism, aggression, and tendency to seek medical treatment can be outcomes of PTSD. Screening and psychosocial intervention are recommended in the field.